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You could be forgiven for wondering why, in the 21st Century people still have to suffer pain and other disabling symptoms in progressive and life-limiting cancer. Global education opportunities for palliative care have been available for some years now, nevertheless there remains wide-scale lack of access to recognized drugs and essential analgesics to relieve symptoms in Asia, Latin America and Africa, in particular. Only half of healthcare workers providing palliative care in these three areas of the world have even a weak opioid always available, leaving aside the most effective and powerful opioid, oral morphine. Tricyclic antidepressants, dexamethasone and anticonvulsants, frequently used as co-analgesics are also widely unavailable. A new report published in September by the UK National hospice charity, Help the Hospices (2007), with an introduction by the World Health Organization (WHO) records these statistics. Perhaps even more disturbing is the fact that 71% of palliative care workers in Asia and 82% in Latin America did not include instruction in either pain relief or opioid use in the professionals’ training curricula. The author of this report is a pharmacist, who conducted a survey for Help the Hospices, as part of its longer term campaign to support palliative care services in poorer parts of the world. Whilst there has been a fairly consistent growth in worldwide palliative care services for cancer patients in particular, there clearly remain many problems for some populations in the countries cited. Remote areas of these countries are specifically cited as vulnerable. As a global community there is a long way to go. Those of us living and working in the developed world are thankfully spared these problems, although ignorance or lack of professional updating may still prevent the sensible use of symptom-relieving drugs. This is quite frankly, unforgivable.

September also saw the latest European Clinical Cancer Conference (ECCO-14), held this year in Barcelona, Spain. ECCO now stands for The European CanCer organization, previously known as FECS, the Federation of European Cancer Societies. Professor John Smyth (President of the Federation of European Cancer Societies and of ECCO-14 and Alexander Eggermont (Chair of the ECCO-14 Scientific Committee and incoming President of ECCO) addressed the conference at its opening ceremony. They gave their commitment for the new European Cancer Organisation to be a much more politically active federation, engaging with policy makers across Europe in particular. Professor Peter Boyle addressed the issue of cancer control, updating the conference that systems across Europe are now in place and working, but this needs to be extended to poorer countries. Dr Tania Estape reported the ignorance and confusion amongst the elderly with regard to their increased susceptibility to cancer because of age. This theme was picked up by Kathy Redmond, Editor of the magazine, Cancer World in her keynote address to the conference. She reminded delegates that there is still far too much complacency about the numbers of elderly people who will be living with cancer and the lack of trained healthcare professionals and resources being provided for this group. She described this issue as a ‘time-bomb’. Nearly 11 million people are diagnosed with cancer every year worldwide, with more than 3 million of those in Europe. Again, there is much to do and a long way to go.

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